Banca de DEFESA: EDER RODRIGUES ARAÚJO

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : EDER RODRIGUES ARAÚJO
DATE: 29/08/2025
TIME: 14:30
LOCAL: Remoto
TITLE:

Effects of Non-Invasive Ventilation with Different Modalities in Patients Undergoing Cardiac Surgery: A Randomized Controlled Clinical Trial

KEY WORDS:

Keywords: Cardiac surgery; Non-invasive ventilation; Pulmonary function; Funtional capacity.

PAGES: 71
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

Introduction: Cardiovascular diseases remain the leading cause of mortality, and while cardiac surgery has become safer, it is still associated with frequent pulmonary complications, increasing morbidity and hospital stay duration. Non-Invasive Ventilation (NIV), particularly CPAP and Bi-Level modalities, has shown potential in preventing atelectasis, improving oxygenation, and reducing reintubation rates, although evidence on the superiority of these modes remains inconclusive. Objective: To conduct a randomized clinical trial to evaluate the efficacy of NIV in three groups (Group 1 - CPAP, Group 2 - Bi-Level, Group 3 - Conventional Physiotherapy) regarding pulmonary function and functional capacity in patients undergoing cardiac surgery at a selected hospital in Campina Grande, Paraíba, Brazil. Methods: A double-blind randomized clinical trial, conducted in Campina Grande, Paraíba, from May to October 2024, assessed the effects of CPAP, Bi-Level, and conventional care in 63 patients undergoing cardiac surgery. Approved by the Ethics Committee (CAAE: 65600722.1.0000.5187) and registered on ClinicalTrials.gov (NCT05966337), the study followed the SPIRIT protocol. Patients aged ≥18 years with hemodynamic stability were randomized into three groups (1:1:1). Primary outcomes included pulmonary function (spirometry) and functional capacity (TUG), while secondary outcomes encompassed hemodynamic variables, pulmonary complications, GPCS, hospital stay duration, and adherence. Interventions were applied in the ICU and ward, with pre and postoperative assessments. Data were analyzed using linear mixed models (LMER) or generalized estimating equations (GEE) in R software, with a significance level of p<0.05. Results: A total of 63 patients undergoing cardiac surgery were analyzed, 65.1% male, with a mean age of 61.4 years and a predominance of myocardial revascularization (63.5%). The sample showed baseline homogeneity. The CPAP group had a shorter hospital stay (β=-0.91 days, p<0.001) and lower prevalence of pulmonary complications (4.8%, p=0.066) compared to the control group (28.6%). Hemodynamic variables showed greater stability in the NIV groups, with significant increases in heart rate (+16.33 bpm, p<0.001) and respiratory rate (+5.71 breaths/min, p<0.001) in the control group. SpO2 significantly decreased in the control group (-2.14%, p<0.001), while NIV groups maintained greater stability. The GPCS was better in the Bi-Level group (β=-1.29, p=0.013). No significant improvements were observed in TUG, FVC, FEV1, or PEF in the NIV groups, but the Bi-Level group suggested less functional deterioration (∆TUG: -2.4s, p=0.33). The control group showed greater functional and respiratory decline, with significant reductions in FVC (-0.85L, p<0.001) and FEV1 (-0.82L, p<0.001). Conclusions: The study demonstrated that CPAP significantly reduces hospital stay duration and suggests a lower prevalence of pulmonary complications in cardiac surgery patients. NIV promoted greater hemodynamic stability, with less increase in heart and respiratory rates in the intervention groups. The Bi-Level group showed better global perception of change and a trend toward more effective spirometric outcomes. Despite limitations such as sample size, the trial reinforces the clinical potential of non-invasive ventilation in this population.

COMMITTEE MEMBERS:
Externo ao Programa - 1754525 - IVAN DANIEL BEZERRA NOGUEIRA - nullPresidente - 1632408 - PATRICIA ANGELICA DE MIRANDA SILVA NOGUEIRA
Externa à Instituição - RAFAELA PEDROSA - UFPB
Externo ao Programa - 3296783 - SAINT CLAIR GOMES BERNARDES NETO - nullExterna à Instituição - ZÊNIA TRINDADE DE SOUTO ARAÚJO